SSS Winch Challenge Nomination Form

SSS Winch Challenge Nomination Form

Please fill in the form below
Please note: This nomination fee does not include Competitors camping fees. Camping fees of $60.00 per vehicle per night will be payable upon arrival at the Landcruiser Mountain Park office. Only towed competition cars are not charged camping, but the tow vehicle is.
Nomination for Round

$350.00 per round

(You can nominate for multiple rounds)
Select Round/s

Round 1 - 22-24 February 2019Round 2 - 10-12 May 2019Round 3 - 2-4 August 2019
Team Name
Driver's Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Post Code
Licence Number*
Phone Number
Mobile*
E-mail*
Navi's Name*
Address*

Street Address

Street Address Line 2

CityState

Post Code
Licence Number
If applicable
Phone Number
Mobile*
E-mail*
Vehicle Information: Registered / Unregistered
Vehicle*
Rego Number
If applicable
Engine Type*
Winch Type*
GPS Model*
Please remember to bring your completed Indemnity form with you each round to be signed in front of an official

Please also complete Medical and Emergency form for first round that you compete in for the series. Bring this completed form with you to the round.

If you are required to provide a statutory declaration, please remeber to bring this with you.

All entry fees must be lodged electronically to:

A/C Name: Custom Performance Offroad

BSB: 124001

A/C Number: 20112846

Ref: Your team name

Please note, payment is required to be received in full no later than 2 weeks prior to each event
Should be Empty:

SSS Winch Challenge Nomination Form

Nomination for Round